| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C.No.194 of 09.06.2022 Decided on : 30-04-2024 Dr.Rajesh Jindal M/s Jindal Heart Institution & Infertility Centre, (A unit of Bathinda Health Care Pvt. Ltd) Powerhouse Road, Bathinda. Jindal Heart Institution and Infertility Centre, Powerhouse Road, (A unit of Bathinda Health Care Pvt. Ltd.) Bathinda, through its Dr. Rajesh Jindal.
........complainants Versus ECHS, Adjutant General's Branch, Maude Line, Delhi Cantt-110010. through its Managing Director, Central Organization. ECHS Hissar Military Station, Hissar-125006, through its Director, Regional Centre.
.......Opposite parties Complaint under Section 35 of the Consumer Protection Act, 2019 QUORUM Smt.Priti Malhotra, President Smt.Sharda Attri, Member Present : For the complainants : Sh.Sahil Bansal, Advocate. For opposite parties : Ex-parte. ORDER Priti Malhotra, President The complainants Dr. Rajesh Jindal & another (here-in-after referred to as complainants) have filed this complaint U/s 35 of Consumer Protection Act, 2019 (here-in after referred to as 'Act') before this Commission against ECHS and another (here-in-after referred to as opposite parties). Briefly stated, the case of the complainants is that Dr.Rajesh Jindal is practicing as D.M. Cardiologist as a Heart Specialist under the name and style of 'Jindal Heart Institution & Infertility Centre', Powerhouse Road, (A unit of Bathinda Health Care Pvt. Ltd.) Bathinda for his livelihood. The complainants are duly authorized by opposite parties for the cashless treatment of ex-servicemen and their families under ECHS scheme and in this regard, opposite parties assured the complainants to reimburse the treatment and hospital charges of their ex-serviceman employees as per their scheme. It is alleged that one patient Dupinder Kaur claim ID 10422860 is duly covered under ECHS cashless scheme. The complainants intimated opposite parties as per condition of the cashless treatment and submitted all the documents and bills of Rs.1783/- with opposite parties under the assurance that the payment will be released to them. It is further alleged that another patient Jaswinder Kaur claim ID 12938349 is also duly covered under ECHS cashless scheme. The complainants intimated opposite parties as per condition of the cashless treatment and submitted all the documents and bills of Rs.1,32,449/- with opposite parties under the assurance that the payment will he released to them. Firstly, the site of opposite parties was not working and files could not be uploaded, but later on, the complainants uploaded the files and also sent e-mails to opposite parties. It is further alleged that the complainants requested opposite parties through letters and several e-mails regarding payments being the beneficiary, but the complainants have not received any payment till date. It is further alleged that opposite parties mentioned vide e-mail dated 21.4.2021 that both the claims are rejected for not uploading the documents and no reply from complainants's end as per audit trail, but the complainants time to time uploaded all the documents and replied all the e-mails sent by opposite parties. The complainants personally visited opposite parties Regional Centre on 3.2.2021 and gave letter to the official of opposite parties. The complainants also got issued legal notice dated 5.7.2021 to opposite parties regarding the pending payments, but till date they neither replied nor released any pending payment to the complainants. It is also alleged that due to the non-payment and illegal withheld of Rs.1,34,232/- (Rs.1,783/- + Rs.1,32,449/-), the complainants have suffered from mental, agony and pains On this backdrop of facts, the complainants have prayed for directions to opposite parties to pay the entire claim under reimbursement of the insurance i.e. Rs.1,34,232/- (Rs.1783/- + Rs.1,32,449/-) alongwith interest @18% p.a. from the date of respective admissions till the date of payment and Rs.20,000/- as compenstion and Rs.20,000/- as litigation expenses. Upon notice, none appeared on behalf of opposite parties. As such, ex-parte proceedings were taken against it In support of their complaint, the complainants have tendered into evidence his affidavit dated 8.6.2022 (Ex.C1) and documents (Ex.C2 to Ex.C8). We have heard learned counsel for the complainants and gone through the file carefully. Learned counsel for complainants has reiterated their stand as taken in the complaint as detailed above. We have given careful consideration to these submissions. It is case of the complainants that they are authorized for the cashless treatment of ex-servicemen and their families under ECHS scheme of opposite parties. The complainants treated two patients Dupinder Kaur and Jaswinder Kaur. Medical files, (Ex.C2 and Ex.C4) proves this fact. After their treatment, the complainants submitted all the documents and bills of Rs.1783/- and Rs.1,32,449/-, (Ex.C3 and Ex.C5) with opposite parties, but opposite parties rejected both the claims of the complainants vide e-mail dated 21.4.2021, (Ex.C7) on the ground for not uploading the documents, but e-mails/letters, (Ex.C6) reveal that the complainants have uploaded the claim documents of both the patients in response to e-mail of opposite parties. Moreover opposite parties have not come forward to contest the complaint of the complainants. Therefore, evidence of the complainants attached with sworn affidavit goes unrebutted and unchallanged. Therefore, there is no reason to disbelieve the version of the complainants. Thus, there is deficiency in services and unfair trade practice on the part of opposite parties. In view of what has been discussed above, present complaint is partly allowed without any order as to cost with the directions to opposite parties to settle the claim of the complainants as per their terms and conditions within 45 days from the receipt of copy of this order. The compliance of this order be made within 45 days from the date of receipt of copy of this order. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record room. Announced 30-04-2024 - (Priti Malhotra)
President (Sharda Attri) Member
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